From the Guidelines
Cirrhosis and alcoholic hepatitis are two distinct liver conditions caused by alcohol abuse, with cirrhosis being a chronic and irreversible condition, and alcoholic hepatitis being an acute inflammatory condition that can be reversible with abstinence. The key difference between the two conditions lies in their underlying pathology and clinical features. Alcoholic hepatitis is characterized by jaundice, fever, abdominal pain, and elevated liver enzymes, and can develop rapidly after periods of heavy drinking 1. In contrast, cirrhosis represents permanent scarring and irreversible damage to the liver tissue, developing gradually over years of alcohol abuse, and is characterized by fatigue, easy bruising, jaundice, fluid accumulation in the abdomen (ascites), and complications like varices and hepatic encephalopathy.
Some key features of alcoholic hepatitis include:
- Acute inflammatory condition of the liver
- Characterized by jaundice, fever, abdominal pain, and elevated liver enzymes
- Develops rapidly after periods of heavy drinking
- Can be reversible with abstinence
- Treatment includes immediate alcohol cessation, nutritional support, and sometimes corticosteroids like prednisolone (40mg daily for 28 days) in severe cases
On the other hand, cirrhosis is characterized by:
- Permanent scarring and irreversible damage to the liver tissue
- Develops gradually over years of alcohol abuse
- Characterized by fatigue, easy bruising, jaundice, fluid accumulation in the abdomen (ascites), and complications like varices and hepatic encephalopathy
- Cannot be reversed, but progression can be halted by stopping alcohol consumption
- Requires management of complications like diuretics for ascites (spironolactone 100mg and furosemide 40mg daily), beta-blockers for varices (propranolol 20-40mg twice daily), and lactulose for encephalopathy (15-30ml three times daily) 1.
The most critical aspect of managing both conditions is complete abstinence from alcohol, as it can lead to significant improvements in survival and quality of life. In fact, a period of abstinence before liver transplantation is often required, with more than 85% of transplantation programs in the United States requiring 6 months of abstinence and careful evaluation by professional counselors to directly address the addiction to alcohol before transplantation 1.
From the Research
Comparison of Cirrhosis and Alcoholic Hepatitis
- Cirrhosis and alcoholic hepatitis are two related but distinct conditions that affect the liver, with cirrhosis being a late-stage complication of alcoholic hepatitis 2.
- Alcoholic hepatitis is a clinical syndrome characterized by acute-onset jaundice and liver enzyme abnormalities in the setting of long-term heavy alcohol use, while cirrhosis is a condition where the liver is scarred and its function is impaired 3.
- The risk of progression to cirrhosis is highest in patients with alcoholic hepatitis, with approximately 10% to 20% of patients with alcohol-associated liver disease developing cirrhosis 2.
Diagnosis and Treatment
- Diagnosis of alcoholic hepatitis is primarily clinical, based on a consensus definition from the National Institute on Alcohol Abuse and Alcoholism, while cirrhosis is often diagnosed through imaging tests and liver biopsy 3, 4.
- Treatment for moderate alcoholic hepatitis primarily consists of supportive care, including alcohol cessation and nutritional support, while corticosteroids are recommended for severe alcoholic hepatitis 3, 5.
- Liver transplantation is the most effective therapy in patients with decompensated liver disease, including those with cirrhosis and severe alcoholic hepatitis 2, 5.
Prognosis and Complications
- The prognosis for patients with alcoholic hepatitis and cirrhosis is generally poor, with a high risk of mortality and complications such as infections, gastrointestinal bleeds, and renal impairment 6, 5.
- The presence of underlying cirrhosis and continued alcohol use negatively impact long-term prognosis, while abstinence from alcohol and management of underlying cirrhosis can improve outcomes 2, 3.
- Corticosteroid therapy can improve survival in select patients with severe alcoholic hepatitis, but it also increases the risk of infections and other complications 6, 5.